Physician Competition and the Provision of Care: Evidence from Heart Attacks

Abstract

We study the impact of competition among physicians on service provision and patients' health outcomes. We focus on cardiologists treating patients with a firsttime heart attack treated in the emergency room. Physician concentration has a small, but statistically significant effect on service utilization. A one-standard deviation increase in cardiologist concentration causes a 5 percent increase in cardiologist service provision. Cardiologists in more concentrated markets perform more intensive procedures, particularly, diagnostic procedures-services in which the procedure choice is more discretionary. Higher concentration also leads to fewer readmissions, implying potential health benefits. These findings are potentially important for antitrust analysis and suggest that changes in organizational structure in a market, such as a merger of physician groups, not only influences the negotiated prices of services, but also service provision.

Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

“…Finally, nine studies were assessed as eligible and the remaining 12 excluded (see Figure 1 ). As shown in Table 1 , five studies were undertaken in the US, 40–44 two in South Korea, 45 , 46 one in Australia, 47 and one in Taiwan. 48 Five studies focused on emergency disease, namely heart attack 40 , 41 , 43 and/or stroke 42 , 48 two sincluded only minor diseases, one on hemorrhoids, 46 other on minor nonsurgical heart episodes, 47 one on all joint-related diseases (eg, knee replacement and hip replacementl), 45 and one on coronary artery–bypass graft (CABG) surgery, which can be an emergency or not depending on the situation.…”

“… 48 Five studies focused on emergency disease, namely heart attack 40 , 41 , 43 and/or stroke 42 , 48 two sincluded only minor diseases, one on hemorrhoids, 46 other on minor nonsurgical heart episodes, 47 one on all joint-related diseases (eg, knee replacement and hip replacementl), 45 and one on coronary artery–bypass graft (CABG) surgery, which can be an emergency or not depending on the situation. 44 …”

“…In terms of empirical models, four studies had added the HHI to the statistical model as a continuous variable, of which two fit the linear probability model, 40 , 42 one applied a multilevel generalized estimate equation model, 45 and the other used a two-level random-intercept logistic model. 47 In the remaining five studies, the HHI was categorized according to either quantiles 41 , 43 , 44 , 46 or self-definition, 48 and different models were applied.…”

“…As for primary outcomes, four studies reported on the impact of competition on 30-day readmission after discharge, 45–48 others reported readmission rates within a time longer than 30 days. 40–44 However, none of them discussed assumptions regarding associations of readmission with quality of care. In terms of secondary outcomes, seven studies reported on the impact of competition on mortality rate 40–45 , 47 , 48 and two on the influence on LOS.…”

The effects of competition on medical service provision

“…He reports that more competition is correlated with a higher level of quality. Dunn and Shapiro (2015) focus on the impact of competition on the quantity and type of health services provided by cardiologists. They observe that, with FFS payment, a higher market concentration increases the use of cardiac catheterization but decreases the probability of a less invasive diagnostic test being performed.…”